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22 - Ovulation Induction

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

By
Evert J. P. Van Santbrink and
Bart C. J. M. Fauser
Edited by
Botros R. M. B. Rizk,
Juan A. Garcia-Velasco,
Hassan N. Sallam and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

Primary treatment of patients presenting with infertility and chronic anovulation aims at restoring normal physiology, that is, selection of a single dominant follicle followed by mono-ovulation (ESHRE Capri Workshop Group, 2003). This process is generally referred to as “ovulation induction.” Alternative protocols for ovarian stimulation used in fertility treatment are (controlled) ovarian hyperstimulation used for intrauterine insemination or in vitro fertilization (IVF). These treatment protocols are aimed at the development of multiple instead of one dominant follicle and thereby result in a nonphysiological condition.

Anovulation is a relatively common problem in the infertility population (approximately, 21 percent of fertility couples; Hull et al., 1985), and it may be considered an absolute factor to prevent pregnancy. Treatment results may be expected to be very good when normoovulatory cycles are restored, in the absence of concomitant fertility problems.

Classification of anovulation is generally based on the combination of a menstrual cycle disturbance (oligo- or amenorrhea) and laboratory findings (Insler et al., 1968; Rowe et al., 1993). The majority of anovulatory patients (about 80 percent, Rowe et al., 1993) will have normal serum concentrations of estradiol (E2) and follicle-stimulating hormone (FSH) and a small proportion (approximately 10 percent) decreased concentrations of both hormones (WHO2 and WHO1, respectively according to the WHO-classification). The remaining group (approximately 10 percent) may be classified as WHO3 and they present with elevated FSH combined along with decreased E2 concentrations resulting in anovulation caused by (imminent) ovarian failure or premature ovarian aging.

Keywords

antiestrogensaromatase inhibitorsdopamine agonistsgonadotropinsnormogonadotropic anovulationlaparoscopic electrocauteryovulation inductionhypogonadotropic anovulation

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Chapter
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Infertility and Assisted Reproduction , pp. 193 - 201
Publisher: Cambridge University Press
Print publication year: 2008

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